Healthcare Provider Details

I. General information

NPI: 1891546776
Provider Name (Legal Business Name): KIANA MOPERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 BACCARAT CT
COLTON CA
92324-9244
US

IV. Provider business mailing address

2258 BACCARAT CT
COLTON CA
92324-9244
US

V. Phone/Fax

Practice location:
  • Phone: 909-677-6972
  • Fax:
Mailing address:
  • Phone: 909-677-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: